Damian Sendler: Behavior and clinical decision-making are influenced by people’s judgments and decisions. More than half of all health problems can be traced back to a person’s unhealthy lifestyle choices. As part of our investigation into how to better understand and improve healthcare decision-making, we conducted a narrative review of the use and examples of concepts from behavioral economics in the three most highly cited general medicine journals in order to better understand and improve healthcare decisions.
Damian Jacob Sendler: Behavior and clinical decision-making are influenced by people’s judgments and decisions. More than half of all health problems can be traced back to poor nutrition, lack of exercise, and substance abuse, according to a recent study. What causes people to make poor health decisions, and how can they make better decisions in the future? As part of our research into Behavioral Economics, we looked at this question through the lens of behavioral science and economics.
Dr. Sendler: Individuals are presumed to be perfectly rational, well-informed, and self-interested in classical economics assumptions. In medicine, doctors make recommendations, prescribe treatments, and provide patients with information in the hope that they will use it to make wise health decisions. According to the Behavioral Economics approach, human behavior frequently deviates from this assumption and that we deviate from making rational choices in predictable ways. Even when we are well-informed, we still make poor decisions regarding our health. Research in behavioral economics helps us understand why we make poor health decisions and how we can improve our decision-making.
There has been a steady rise in the use of behavioral economics in a wide range of industries over the past few decades. Many Nobel Prizes in the field of behavioral economics have been awarded to researchers, including Daniel Kahneman (2002) and Richard Thaler (2007) (2017). Nudge units have been established in government to apply Behavioral Economics insights to public policy. When it comes to making better business decisions, companies employ the services of Behavioral Economics consultants. Books on the subject have been bestsellers in popular culture.
Behavioural Economics is based on the premise that our limited cognitive resources limit our ability to make decisions. Decision-making requires a lot of time, effort, and mental effort. Fast (System 1) and slow (System 2) decisions are described by Kahneman. This type of decision-making requires minimal cognitive resources because it’s so simple. Most of the decisions we make during the course of the day can be made quickly. Slow decisions are deliberate, deliberate, and effortful…. Decisions that are rational, complex, or consequential are best served by taking their time.
Examples of the impact of cognitive limitations on health decisions can be found in the quotes that follow. Decision-making under uncertainty can be impacted by a lack of cognitive resources, which affects both clinicians and patients. “ Medical knowledge and cognitive demands have grown at an exponential rate, but the brain’s capacity to keep up hasn’t. However, despite the fact that it is impossible to know everything, the diagnostician of today is unable to find ways to reduce the cognitive load in daily practice, despite being aware of this fact. Diagnosticians of the future can avoid this problem by using checklists and decision support systems on a regular basis, which frees up their mental bandwidth for more complex issues. ” “Patients often face unique health problems, receive little useful feedback on the quality of medical decisions, and make decisions when they are ill and therefore more emotionally charged. Therefore, it is not surprising that patients’ actions may not always be completely rational. For an ill or vulnerable person, weighing the costs and benefits of alternative tests or treatments can be difficult.”
We use heuristics (shortcuts) to speed and simplify decisions because it is not possible to apply slow decision-making to the countless decisions, both trivial and critical, we make every day. In most cases, the results of taking these short cuts are exactly what was intended. Using heuristics and biases to make decisions, on the other hand, can lead to unexpected results.
In health-related decision-making, many of the heuristics and biases identified have significant consequences. When it comes to probabilities, we use heuristics to make up for our lack of knowledge, as noted by Tversky and Kahneman. Representation, availability, and anchoring and adjustment heuristics are all closely linked to clinical decision-making (Table 1). Therein lies the core of clinical reasoning, which deals with uncertainty and probability estimation.” Clinicians often use heuristics (also known as subjective probabilities or beliefs, also known as clinical judgment), either implicitly or explicitly, when estimating the likelihood of a patient’s illness.”
If you’re making health-related decisions, “present bias” and “loss aversion” can have a negative impact (Table 1). Kahneman and Tversky also noted that people make decisions not on the basis of absolute gain or loss but on gain or loss relative to a reference point. There are important implications for health-related decisions based on this observation. Compared to their current health, disability and death appear inconceivable to healthy patients. When viewed in this light, the disparity between the two states of health is negligible. Patients who are in poor health have a more acute awareness of the difference between their current condition and death. From this perspective, the disparity appears to be quite significant. Poor health may lead to a greater desire for aggressive treatment, even if it results in long-term disability or discomfort, whereas patients who are in good health may not see the value in such treatment.”
Table 1 provides a summary of other heuristics and biases that have important implications for health and medicine.
This literature review lacked an important theme: bias blindness, the idea that we are better at spotting bias in others than we are within ourselves. Patients and clinicians may have difficulty communicating effectively because of their shared biases, which can lead to miscommunications and misunderstandings. Practicing mindfulness, actively open-minded thinking, and metacognition have been suggested as ways to combat this bias and others like it., Both of these strategies are based on the idea that a systematic, deliberate, and deliberate thought process (System 2) is necessary to identify and reduce bias.
Damian Jacob Markiewicz Sendler: Our decision-making is heavily influenced by our social environment. Social norms, social signaling, modeling, and contextual cues all influence our tendency to be social beings. Socioeconomic status, education, psychological issues, social support, and income inequality all have an impact on people’s decisions. Decisions are influenced by social media, advertising, and persuasion. Even the anticipation of social considerations and pressures can influence decisions.” Obesity epidemic may be linked to the spread of obesity in social networks. It’s possible, given the importance of social influence, to slow the spread of obesity by using that same force. People’s perceptions of their own risk of illness may be influenced by the people around them, and this could be exploited to spread positive health behaviors.”
One of the best examples of the impact of social factors on our behavior, and thus our health, is our response to the SARS-CoV-2 pandemic and the severity with which it impacted certain communities and ethnic groups.
The following comment exemplifies the importance of taking into account social factors when making decisions and altering behavior because it shows how environment and social interactions interact.
As a complex system problem, obesity prevention is framed as a complex systems problem, for which food and physical activity behaviors are not only a matter of individual choice but also strongly influenced by multiple levels of socioenvironmental risks, i.e. interpersonal level (family, peers and social networks), community level (schools and workplaces) as well as by the interaction with government level policies.”
We can use our knowledge of heuristics and biases to make better decisions by using choice architecture, which has long been used by advertisers and marketers to create a favorable decision-making environment. Adverts and used car salesmen already knew what Tversky was looking at, according to Tversky. Table 2 provides an overview of various types of choice architecture.
Choice architecture (and nudges in particular) have been criticized for their potential to be used as a tool of control. Some researchers, such as Thaler and Sunstein4, argue that nudges should be used responsibly and note that a true nudge does not limit people’s freedom of choice but rather directs them toward more beneficial outcomes for themselves. One of the goals is helping people overcome their unhealthy habits so that they can achieve and maintain a healthy lifestyle. There is a counterargument that the choice architecture is already in place, but it is not necessarily implemented with the welfare of individuals in mind (eg, advertising, social media). Health can be improved by making environmental and social cues more deliberate and targeted. For example, “behavioral economics has shown that removing even minor hurdles can greatly improve the uptake of helpful practices.”
Damian Sendler
As previously stated, humans have a hard time dealing with uncertainty. Health and medicine face a major challenge in this regard. Making rational decisions about one’s health often necessitates weighing the relative risks of various treatment options, which can be difficult for both doctors and patients. Using choice architecture, systems, clinicians, and individuals can access accurate information and probability calculations to prevent errors and increase the likelihood of successful behavior.
Damien Sendler: A lack of cognitive resources has been both exacerbated and mitigated by the use of technology. The speed and volume of information that can be accessed by both clinicians and patients has increased tremendously as a result of technological advancements. Our ability to comprehend and utilize this information remains constrained. Technology is being used to improve clinical decision-making and health-related decisions as we learn more about how humans make decisions and the limitations of human decision-making. Using choice architecture, the physical and social environments can be shaped to address behavioral health challenges and reduce medical errors, as outlined in Table 2.
Many decisions that were once slow can become quick as expertise grows with time, practice, and timely feedback and learning in a regular environment. Medical diagnoses and scientific expertise are two examples of how people with expertise in a discipline can use language to communicate complex collections of phenomena. The ability to recognize patterns and generate codes of intended behavior may also be enhanced through practice with a vocabulary and concepts for characterizing and labeling decision-making tendencies. The consequences of these tendencies, capacities, and errors in decision-making could be better understood, anticipated, and communicated as people learn and teach about them. Diagnoses are diagnostic tasks that require precise vocabulary, just like in medicine.” Disease names serve as the hooks to which all of the disease’s vulnerabilities, environmental factors and symptoms are attached. “Prognosis and care” are also attached to disease names.
There is a chance that as groups of people and clinicians come together, they can collectively identify, anticipate, and avoid systemic mistakes. Scientific and systematic approaches can be used to ask and answer questions and develop solutions for identified problems.. It’s possible to consider alternative viewpoints and perspectives from the outside. When resolving differences, it’s best to put an emphasis on finding solutions that benefit both parties. Furthermore, as noted earlier in this article, the availability of accurate information and probability calculations may help prevent errors and increase the likelihood of successful behavior.
Damian Jacob Sendler
Genotype, phenotype, and behavior, including the ability to make decisions, are all highly variable in humans. Toxicology and efficacy may differ between individuals because of their differing ability to metabolize drugs. Precision medicine has grown out of the discovery of these small differences. Individual human behavior, including decision-making, is rarely consistent. Even if the circumstances appear to be identical, the same person may choose a different course of action at a different time. These variations can be inherited, acquired, or a combination of the three. Individual health and well-being can only be improved by a thorough examination of the impact of the socioeconomic, psychological and physical environments.
When it comes to achieving some stability, Kahneman notes that loss aversion and the status quo bias can be beneficial. An additional area in which behavioral economics can be applied to improve health is the exploration of the role of innovation and creativity in relation to loss aversion and the status quo bias. In the lives of both institutions and individuals alike, loss aversion is a powerful conservative force that favors minimal changes from the status quo.” The gravitational force that holds our life together near the reference point is this conservatism, which helps to keep us stable in our neighborhood, our marriage, and our jobs.
When it comes to research and development, innovation, invention, and creativity, Behavioral Economics pays little attention to how people behave as individuals or in groups. Some have suggested that people become accustomed to the current state of affairs (the status quo) and then strive to improve their own and others’ lives even more. Perhaps our prosocial and cooperative tendencies motivate us to recognize current suffering and work to “change the world” so that we can live together more successfully: fed, safe, healthy, educated, and skillfully interconnected. We strive to protect ourselves and our loved ones from financial ruin.
It was the goal of this narrative review to provide examples of how Behavioral Economics concepts and applications in health and medicine have been discussed in high-impact articles in the broader medical community. Other concepts that may have the potential to improve health-related decision-making were also identified.
Behavioural Economics provides a useful conceptual framework for thinking about decision-making and its limitations (System 1, System 2, cognitive limitations), reveals the reasons behind why we sometimes make poor decisions regarding health (present bias; loss aversion; inappropriate use of heuristics) and suggests ways to improve decisions (choice architecture, scientific method, and learning, teaching, and negotiating). A wide range of people (doctors, scientists, patients), groups (health care teams, research teams), society (public health and policy), and institutions (such as universities) could benefit from this approach (academic medical centers and government). It’s hard to imagine that more than half of all health problems could be eliminated through improved decision-making abilities if we were able to learn, practice, work with others, and make changes in our eco-social environment.
Finally, Kahneman stresses the importance of acknowledging the role of chance and luck in the outcomes of decisions and behaviors:
“I believe that the message of luck encourages us to be more forgiving of the mistakes of others.” Trying to figure out what people did wrong because something went wrong is something that we do far too often. Over-explaining and over-blaming are two of the most common ways that people express their feelings. There’s no guarantee that we’ll be able to do everything we can, but the recognition of the role of luck and limited control should help us deal with that.
Having a better grasp of probabilities and human cognitive limitations can help people appreciate the difficulties and necessity of living with uncertainty. To conclude, we should acknowledge the importance of compassion, generosity, and humility in our lives, as well as in the lives of others.
